NEW PATIENTS

New Patient Forms and Information

Bremen Family Health & Wellness Center and Axiom Chiropractic

Doctor and patient

Forms for New Patients

Prior to your appointment at Bremen Family Health & Wellness Center and Axiom Chiropractic, you have the option to print out and complete our new patient forms in the comfort of your own home. Please consider the following:


  • If you do not already have AdobeReader® installed on your computer, click here to download it.
  • Download the necessary forms below, print them out, and fill in the required information.
  • Fax us your printed and completed forms or bring them with you to your appointment.


New Patient Health History Form - Required

New Patient Online Form


The New Patient Health History form lets us know the history and current state of your health. What questions, concerns, and goals, regarding wellness can we help you with? Let us know!

What Can I Expect During My Appointment?

You should expect your first visit to Bremen Family Health & Wellness Center and Axiom Chiropractic to last about 1- 1½ hours. Dr. Templeton is very thorough, and every new patient is given a high amount of individualized attention.


  1. All new chiropractic patients are requested to fill out the personal health history questionnaire.
  2. A 1-on-1 consultation with the doctor will be done to discuss your health problems and to determine what may be the cause.
  3. A comprehensive examination and evaluation including any tests necessary to determine the precise cause of your problem is given.
  4. The doctor will advise if additional tests or x-rays are needed.
  5. You will be given a report of findings and the cause of your problem will be discussed. This report includes a thorough explanation of our treatment recommendations and what results can be obtained. You will also be advised concerning how our office procedures work.
  6. If you are accepted as a patient, care will begin. Additional explanations will be given on the different types of treatments that are available in the office.
  7. An estimate of the future care that is needed will be given. Upon your acceptance, care will continue until the personal maximum correction of your problem has been obtained.
  8. After maximum correction has been obtained, a schedule of care will be recommended to help prevent future problems and maintain good health.
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